Sarah Poggi

Inova · Antenatal Testing Center

The effects of pelvic artery embolization (PAE) for post-partum hemorrhage (PPH) on subsequent pregnancies have been explored in small case series and one case-control study by mailed questionnaire with uncomplicated pregnancies as controls. We conducted a single center retrospective cohort study using women with PPH without PAE for comparison. Fro...

Objective: To evaluate the efficacy of fetal fibronectin (fFN) testing in cervical cerclage patients presenting with acute signs or symptoms of preterm labor. Methods: A total of 71 fFN tests were performed in 48 women between 23 and 34 weeks' gestation who presented at two institutions at risk for imminent delivery with cerclage in situ. Results:...

Objective: To study the relationship between body mass index (BMI) and gestational age (GA) at delivery in patients with cervical insufficiency (CI) undergoing cerclage. Study design: We accessed a database of patients with singleton gestations undergoing cerclage (N=168) for a well-characterized history of CI, shortened cervix <2.5 cm with a hi...

To report a case of embryopathy due to misadministration of methotrexate in the setting of suspected ectopic pregnancy that resulted in a different pattern of malformations than is typically seen with methotrexate. Case report. Community hospital. A 30-year-old primigravida women exposed to methotrexate (50 mg/m(2)) at 5 6/7 weeks' gestation. The p...

To evaluate perioperative complications of history- and ultrasound-indicated cerclage. We performed a retrospective observational study of a cohort of patients who underwent history- (n = 198) or ultrasound-indicated (n = 89) cerclage procedures. We evaluated the rates of perioperative complications based on indication for cerclage. The χ(2) was us...

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Placental meconium has been associated with poor perinatal outcomes but the reliability of the diagnosis has not been assessed. Our objective was to assess the interobserver variability in detection of placental meconium uptake. Ten pathologists from two community and four university hospitals reviewed 10 hematoxylin and eosin-stained placental sli...

Our objective was to determine whether obstetric history affects the efficacy of therapeutic cerclage. Data were gathered prospectively on patients receiving therapeutic cerclage, defined as midtrimester presentation with a cervical length less than 2.5 cm and prior preterm delivery or cervical dilatation with visible membranes on sterile speculum...

Oligohydramnios is related to adverse perinatal outcomes particularly when associated with fetal growth restriction. The purpose of this study was to delineate predictors of adverse perinatal outcomes in cases of preterm idiopathic oligohydramnios associated with appropriate-for-gestational-age (AGA) fetal biometry. A database of preterm AGA fetuse...

Fetal lung maturity tests are performed on amniotic fluid and they evaluate fetal lung maturation either by quantifying components of pulmonary surfactant (e.g. lecithin, phosphatidylglycerol, or lamellar bodies) or by measuring the surface active effects of the phospholipids in the surfactant.

The purpose of this study was to evaluate the clinical utility of cerclage in low risk women with cervical length (CL) < or = 25 mm at transvaginal ultrasound (TVU). This was a retrospective cohort study of women with CL < or = 25 mm identified incidentally at TVU examinations between 16(0/7) to 24(6/7) weeks, with no history of previous preterm bi...

Cervical insufficiency with dilation can be associated with amniotic fluid microbial invasion. Cerclage placement in the presence of infection is contraindicated because it is associated with poor fetal and maternal outcome. A 30-year-old gravida 4 para 0 with cervical insufficiency had emergent cervical suture placement at 19 weeks. The patient un...

In humans, cerebral palsy (CP) may originate from inflammation during the second and third trimesters of gestation when preoligodendrocytes (Pre-OL) are most vulnerable to an inflammatory insult. We studied a postnatal CP model to evaluate injury that would correlate with presence of Pre-OL in human pregnancy. On postnatal (P) days 2, 3, 4, 5 and 6...

Cervical insufficiency can be unexpected in a woman with a previous term birth. Our objective was to determine what risk factors, if any, place women with a term delivery at risk for cervical insufficiency in a subsequent pregnancy. Demographic characteristics were collected for a cohort of women with at least 1 previous term birth followed by cerv...

This study was undertaken to evaluate if the previously demonstrated relationship between macrosomia (> 4000 g) and polyhydramnios (> 25 cm) is linear across birth weights (BW) in diabetic patients with poor glycemic control. Using a prospectively collected database of patients undergoing amniocentesis for fetal lung maturity for various indication...

Risks of third-trimester amniocentesis are considered minimal; however, only case series have been reported. We performed a case-control study in which women undergoing third-trimester amniocentesis were matched with controls undergoing antenatal testing for similar indications to determine adverse outcomes associated with the procedure. Cases unde...

To determine if an obstetric birthing simulator can improve medical student understanding of and comfort with basic obstetric procedures. Medical students were surveyed at the end of their obstetrics rotation regarding their knowledge and comfort with basic obstetric procedures. A group of students was trained on basic procedures utilizing an obste...

Vasoactive intestinal peptide (VIP)-related peptides prevented the learning deficit in the offspring in a model for fetal alcohol syndrome. We evaluated whether the mechanism of the peptide protection included NR2B, NR2A, and GABAAalpha5. Timed, pregnant C57BL6/J mice were injected on gestational day 8 with alcohol (0.03 mL/kg), placebo, or alcohol...

Alcohol-related neurodevelopmental disorders are contributors to long-term learning disabilities. By using a model for fetal alcohol syndrome, we have shown that prenatal alcohol exposure results in adult learning deficits of unknown mechanisms. In the developing hippocampus, the N-methyl-D-aspartate (NMDA) receptor subunit NR2B triggers long-term...

Cerebral palsy (CP) is characterized by motor deficits. There is increasing evidence that CP may result from inflammatory and infection-mediated white matter damage. Our objective was to develop an inflammatory model for CP based on chronic lipopolysaccharide (LPS) exposure with a recognizable phenotype in offspring. On gestational days 15, 17, and...

Prenatal alcohol exposure results in fetal death and neurobehavioral complications including learning impairment. Previously synthetic peptides derived from activity-dependent neurotrophic factor have been shown to prevent aspects of alcohol-induced damage in pregnancy. The objective of this work was to evaluate whether activity-dependent neurotrop...

Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. We compared AMA patients presenting for prenatal care who u...

Cerebral palsy (CP) is associated with childhood spasticity, seizures, and paralysis. Oligodendrocyte damage resulting in periventicular leukomalacia (PVL) in the developing brain has been implicated. Animal models of CP have used prenatal hypoxia and infection with histopathology of PVL as the end point. To evaluate whether this histologic end poi...

Lamellar body count is a new and fast technique to establish the presence of fetal lung maturity. We have assessed the predictive ability of lamellar body count for neonatal respiratory distress syndrome (RDS) in a non-diabetic population. We accessed a cohort of amniocenteses in non-diabetic women from 1998 to 2002 (n=102). Neonatal RDS was define...

To describe and analyze delivery notes after a shoulder dystocia drill with a birthing simulator A total of 33 residents from 2 university training programs underwent testing on a standardized shoulder dystocia scenario with an obstetric birthing simulator. After the completion of the delivery, each resident was informed of the infant's Apgar score...

In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delivery force is reduced with the prophylactic McRobert...

Epidural anesthesia (EA) is used in 80% of vaginal deliveries and is linked to neonatal and maternal trauma. Our objectives were to determine (1) whether EA affected clinician-applied force on the fetus and (2) whether this force influenced perineal trauma. After informed consent, multiparas with term, cephalic, singletons were delivered by 1 physi...

To determine whether a simulation training scenario improves resident competency in the management of shoulder dystocia. Residents from 2 training programs participated in this study. The residents were block-randomized by year-group to a training session on shoulder dystocia management that used an obstetric birthing simulator or to a control grou...

Placental trophoblast invasion and amniotic fluid cytokine receptor levels have been reported to vary with fetal gender. We investigated whether fetal gender affects amniotic fluid levels of the inflammatory cytokines interleukin (IL)-6 and IL-10 and the pro-angiogenesis cytokine angiogenin. Specimens from singleton gestations undergoing mid-trimes...

To assess the role of transvaginal sonographic cervical length in predicting spontaneous preterm delivery at < 32 weeks in patients with both triplet pregnancy and therapeutic cerclage. The maternal records of all triplet pregnancies with therapeutic cerclage and sonographic cervical length before and after cerclage were reviewed (n = 17). Each of...

Multiple gestations are known to be at increased risk for pulmonary edema. Our objective was to characterize this morbidity in a cohort of triplet pregnancies. Charts from triplet pregnancies managed by the Georgetown University Hospital Maternal-Fetal Medicine service were abstracted for demographic information and complications. Cases who develop...

To evaluate whether operative vaginal delivery worsens the extent and/or degree of permanent brachial plexus injury. We utilized a dataset (n = 104) of vaginal deliveries resulting in permanent brachial plexus injury that ultimately underwent litigation. We excluded patients on whom neonatal injury information was incomplete (n = 5). Patients who h...

The purpose of this study was to compare maternal, neonatal, and second stage of labor characteristics in shoulder dystocia deliveries that result in permanent brachial plexus injury with shoulder dystocia deliveries that result in no injury. Our cases were culled from a database of deliveries that resulted in permanent brachial plexus injuries and...

Fetal alcohol syndrome (FAS) results in stillbirth, fetal growth restriction, and mental retardation with injury attributed to oxidative stress. Our objective was to identify signal transduction pathways expressed in a model of FAS and to quantify expression of c-fos, a gene in the stress signal pathway. Timed, pregnant C57Bl6/J mice were injected...

Fetal alcohol syndrome (FAS) is the most common nongenetic cause of mental retardation. Peptides NAPVSIPQ (NAP) and SALLRSIPA (SAL), related to activity-dependent neuroprotective protein (ADNP), prevent alcohol-induced damage in a mouse model of FAS. Our objective was to characterize ADNP in this model to relate this protein to the mechanisms of da...

A significant increase in the triplet birth rate has occurred recently. This rise is of concern, as these infants are historically reported to be at risk of adverse outcome. Thus, we examined the outcome of triplet births in a large contemporary case series. Since 1993, detailed clinical data have been collected on all patients admitted to our Neon...

Delivery of the posterior arm, or the Barnum maneuver, is at times used late in shoulder dystocia management algorithms, and is not often a first- or second-line management protocol. A multiparous, diabetic patient, who was morbidly obese and had a residual obstetric brachial plexus injury, experienced a precipitous second stage of labor and severe...

The current recommendation for management of antepartum eclampsia is to take steps to deliver the fetus after stabilization of the maternal condition. We delayed delivery for 60 hours in a case of antepartum preterm eclampsia to allow administration of corticosteroids for fetal lung maturity enhancement. A primigravida presented with eclamptic seiz...

BACKGROUND: Delivery of the posterior arm, or the Barnum maneuver, is at times used late in shoulder dystocia management algorithms, and is not often a first- or second-line management protocol. CASE: A multiparous, diabetic patient, who was morbidly obese and had a residual obstetric brachial plexus injury, experienced a precipitous second stage o...

To assess which values of the lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC) optimally correspond to the presence of phosphatidylglycerol (PG). A database of clear amniotic fluid specimens obtained by amniocentesis was accessed. Receiver operating characteristic curve analysis was performed for both L/S ratio and LBC to identify t...

We report on a tactile force-sensing glove worn by an obstetrician to measure the force applied on a fetal head during childbirth. The glove consists of five piezoresistive sensors strategically placed to measure normal forces applied to the head. The normal forces are converted to traction forces via laboratory calibrations. The sensors interface...

Activity-dependent neuroprotective protein (ADNP) potently enhances the survival of neurons and is regulated by vasoactive intestinal peptide, which also mediates postimplantation mouse embryonic growth. The objective of this study was to characterize ADNP in mouse embryonic tissues throughout development. Developmental tissues (embryo, decidua, pl...

The purpose of this study was to evaluate which variables predict neonatal depression in vaginal deliveries that result in permanent brachial plexus injury. With the use of a data set of litigated vaginal deliveries (n = 103 deliveries) from 1978 through 1999 that resulted in permanent brachial plexus injury, detailed delivery and neonatal and pedi...

To establish whether cervical length is a predictor of spontaneous preterm delivery at < or = 32 weeks in triplet pregnancies. This was a case-control study of all triplet pregnancies followed with more than three sonographic assessments of cervical length at 4-week intervals from 1995 to 2000. Cervical length in women delivered spontaneously at <...

Placental calcification commonly increases with gestational age. The mechanism of apatite mineralization probably involves one of three known mechanisms of tissue calcification: physiological (like bone), dystrophic (ischaemia-related) or metastatic (mineralization in a supersaturated environment). This study was designed to determine the mechanism...

Primary melanoma originating in the gastrointestinal tract is very rare and the majority of these tumors arise in the mucosa of the anus or rectum. A case of solitary colonic melanoma in a 79-year-old man is described with a review of pertinent literature. The surgically excised neoplasm was evaluated by routine histology and immunohistochemistry s...

Psammocarcinoma is an unusual variant of serous cystadenocarcinoma characterized by heavy deposits of psammoma bodies. This disease has been suggested to be similar to carcinomas of low malignant potential in its indolent clinical course. We present this case report of an aggressive course of this disease to alert others that psammocarcinoma may no...

Thin sections of breast tissues from patients with possible tumors also contained closely associated mineral deposits. Using scanning electron and backscattered electron micros- copy (SEM-BSE) energy and wavelength dispersive chemical analyses, we found the de- posits ranged from ,1 m mt o 50mm in size and were composed predominantly of calcium pho...